Healthcare Provider Details

I. General information

NPI: 1629513486
Provider Name (Legal Business Name): AZ SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5133 N CENTRAL AVE SUITE 100
PHOENIX AZ
85012-1438
US

IV. Provider business mailing address

5133 N CENTRAL AVE SUITE 100
PHOENIX AZ
85012-1438
US

V. Phone/Fax

Practice location:
  • Phone: 602-279-0044
  • Fax: 602-279-0088
Mailing address:
  • Phone: 602-279-0044
  • Fax: 602-279-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NIKKI VAUGHAN
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 602-279-0044